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Bryan Mulley, Steve Hudson and Peter
Taylor are
academic pharmacists
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Observations wanted
Networks of teacher-practitioners are now being
assimilated into schools of pharmacy to secure the quality of patient-centred
teaching — as reported by Fitzpatrick et al (PJ, 10 February,
p165). Yet clinical pharmacy postgraduate education is apparently
still not addressing the higher aspirations of community pharmacists
according to Davis and Steel (ibid, p162), who suggest the need
for a makeover of postgraduate provision.
Did the formalisation of MSc postgraduate clinical training of
hospital pharmacy secure the future of hospital pharmacy and of
clinical pharmacy in the curriculum, as Mulley et al suggest here?
And did it still fall short of providing a postgraduate training
for community pharmacists in the clinical skills envisaged by the
new NHS environment? The authors would welcome contributions that
discuss these points. |
The report of the 25th
anniversary of the UK Clinical Pharmacy Association (PJ, 18 November 2006, p612) stimulated us to reflect on the development of clinical pharmacy in the UK through our experience of the first master's degree in clinical pharmacy at the University of Bradford. The course
predated the establishment of the UKCPA by almost a decade (1972) and
was followed by similar development of an MSc in clinical pharmacy at
the University of Strathclyde before the MSc went on to become the UK
pathway in most schools for the education of clinical pharmacists.
The early decision to establish at master’s level the combined
clinical education with clinical training of pharmacists had the effect,
fundamentally, of producing the capacity to provide three key aspects
of clinical pharmacy continuing professional development, namely, patient-centred
teaching, bed-side application of pharmaceutical science and practice
research. The decision to establish clinical training at MSc level paved
the way for the introduction of a bed-side approach to patient-centred
teaching into the undergraduate curriculum 20 years later (with the expanded
four-year UK course in the late 1990s). Practice research was also stimulated
but likewise took almost another 20 years to become established with
the first chairs in pharmacy practice in the UK schools of pharmacy created
in the early 1990s.
It is interesting to recall, almost 35 years on, the important changes
in education and practice at that time. The changes came about through
the vision of a few far-sighted professional leaders who saw beyond routine
management of under-staffed traditional services to draw on advances
elsewhere, particularly in the US. In 1969 Bradford benefited by the
approach of a key visionary, Colin Hetherington, a Leeds hospital chief
pharmacist who had seen at first hand some of the early clinical pharmacy
developments in the US. Professional leaders throughout the UK saw not
only the opportunity but also the need for the profession to take a quantum
leap forward. Postgraduate degrees were posited as part of the solution.
Patient-centred teaching
The Bradford course predated the availability of pharmacist teacher-practitioner
role models, which Harding and Taylor (PJ, 23/30 December 2006, p766)
recognise are now central to UK undergraduate curricula and which are
still rare in European schools of pharmacy. In the 1970s co-operation
with equally visionary medical staff initiated the teaching of “therapeutics” before
this subject gained a respectable position in the now four-year MPharm
UK degree.
A key step was for medical staff to introduce MSc students to the experience
of ward rounds. The ward work was reinforced by written analysis of cases
the students had personally met and interviewed. The use of case studies
was a step forward that the UKCPA had the vision to promote in its conference
and travelling workshop programmes in the early 1980s. The concepts of
case presentation and case discussion were unheard of in UK schools of
pharmacy undergraduate curricula until the late 1980s and only emerged
in the 1990s. By the early 1990s a number of the practitioners influenced
by the Bradford course had developed a novel master of education course
in clinical teaching with Leeds University to formalise the patient-centred
teaching approach.
Since the late 1990s UK pharmacists have been extending the impact of
bed-side teaching through collaboration within the European Society of
Clinical Pharmacy. Such contributions are well received by pharmacists
from other countries that have not yet evolved a postgraduate clinical
pharmacy education.
Bed-side application of pharmaceutical science has been well illustrated
by the translation of pharmacokinetics, at that time a young theoretical
subject, into one that could be applied at the bed-side. In Bradford
the undergraduate teaching was expanded to master’s level in a
way that inspired many of the Bradford graduates to work more comfortably
with the subject in daily practice. Pharmacokinetics in the MSc was not
taught at that time as a subject with routine clinical application; rather,
the students had to gain the confidence from an enjoyment of the
subject in order to find ways, themselves, of applying and manipulating
the concepts. The use of kinetics to individualise doses in patients
with renal impairment, for instance, is now part of the core skills of
practising
pharmacists. Practice research
The receptiveness to the research approach that the MSc course initiated
probably helped the wider development of pharmacy practice research.
Dissemination of student projects at European Symposia on Clinical
Pharmacy in 1978 and 1979 must have been among the earliest examples
of UK hospital pharmacists’ original contributions to international
conferences. Some of these projects were of a sufficient standard for
publication.
One distinct but unplanned advantage of this practice research was
application to new patient services and the identification of candidate
patient groups
which would form suitable case-loads for those clinical pharmacists.
To the student at that time the educational experience underlined the
logic of the need for the status of practice research to be advanced
nationally; indeed it was, notably championed by the efforts of another
Bradford academic leader (Geoffrey Booth) through his influence as chairman
of the British Pharmaceutical Conference practice research adjuducating
committee.
The MSc clinical pharmacy programmes contributed to the establishment
of what can now be seen as a distinctive UK pattern of “pharmaceutical
care” developments. In a nutshell, the original vision to upgrade
what the pharmacist offers in terms of “clinical pharmacy” knowledge,
skills and attitudes has been translated by continued professional development
and multidisciplinary thinking into the delivery of “pharmaceutical
care” — a term which best describes what the patient receives
from a team in which the patient is an active participant. The acceptance
of the term “pharmaceutical care” has allowed the profession
to teach and research gaps and improvements in quality of medicines use
in terms of multidisciplinary teamwork and public health strategies.
The steps taken by graduates of those early hospital-orientated MSc courses
have had an impact on the profession through wider educational changes
and by affecting the aspirations of community pharmacists. Students in
2007 are entering a transformed landscape of community and hospital practice
opportunities that were unimaginable 35 years ago. The future shape of
practice and the next stages of educational development may not be entirely
clear, but we now know from history that they depend on the ideas being
developed between academic and practising pharmacists today, which we
trust the Society will continue to activate. |
The
Pharmaceutical Journal